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Gestational Trophoblastic Disease Treatment (PDQ®)

Stage Information for Gestational Trophoblastic Disease

Hydatidiform Mole (HM)

HM (molar pregnancy) is disease limited to the uterine cavity.

Gestational Trophoblastic Neoplasia

Definitions: FIGO

The Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) and the American Joint Committee on Cancer (AJCC) have designated staging to define gestational trophoblastic neoplasia; the FIGO system is most commonly used.[1,2] Some tumor registrars encourage the recording of staging in both systems.

bTo stage and allot a risk factor score, a patient's diagnosis is allocated to a stage as represented by a Roman numeral I, II, III, and IV. This is then separated by a colon from the sum of all the actual risk factor scores expressed in Arabic numerals, i.e., stage II:4, stage IV:9. This stage and score will be allotted for each patient.

Stage

I

Disease confined to the uterus.

II

GTN extends outside of the uterus, but is limited to the genital structures (adnexa, vagina, broad ligament).

III

GTN extends to the lungs, with or without known genital tract involvement.

IV

All other metastatic sites.

Modified WHO Prognostic Scoring System as Adapted by FIGOb

Scores

0

1

2

4

Age

<40

≥40

–

–

Antecedent pregnancy

mole

abortion

term

–

Interval months from index pregnancy

<4

4–6

7–12

>12

Pretreatment serum hCG (iu/1)

<103

103–104

104–105

>105

Largest tumor size (including uterus)

<3

3–4 cm

≥5 cm

–

Site of metastases

lung

spleen, kidney

gastrointestinal

liver, brain

Number of metastases

–

1–4

5–8

>8

Previous failed chemotherapy

–

–

single drug

≥2 drugs

In addition, the FIGO staging system incorporates a modified WHO prognostic scoring system. The scores from the eight risk factors are summed and incorporated into the FIGO stage, separated by a colon (e.g., Stage II:4, Stage IV:9, etc.). Unfortunately, a variety of risk scoring systems have been published, making comparisons of results difficult.